MEALTIMEINDEPENDENCE

By: Carmen Willingsteachingvisuallyimpaired.comMealtime can be a struggle for many students, but can provide unique challenges to students with visual impairments. Although it may be easier and possibly neater to feed the student or to provide extra assistance, it is not appropriate when the student has the ability to feed themselves.

It is essential to promote mealtime independence not only to build independence, but to promote social acceptance as well. To help the student develop the skill of feeding themselves, place the food on a table or tray in front of them. At first, assist the student by using verbal cues and hand-under-hand assistance to help them locate and pick up the food. Provide finger foods: pieces of cracker, ice cream cone, spaghetti to promote finger sensitivity. Peel eggs, fruit, and wrapping on some containers to develop skillful hands.There are a number of adaptations that can be made to make mealtimes easier. Use high contrast utensils and dishes for students with low vision. Bowls and plates with suction cups can help them stay in place. Similarly, Dycem or other non-skid materials can be used as mats to prevent sliding. Exposing children to a variety of foods with a variety of textures and flavors can help develop tactual discrimination skills. When assisting students in eating, guide the student by sitting behind them and provide hand under hand support. Younger children can be taught to spear with a fork by using their opposite hand to assist in touching food that needs to be speared and aid in the placement of the fork. As students get older and more adept, they can be shown how to use a piece of bread or the edge of a knife or spoon as a “pusher”. A common strategy to teach students to locate food on their plate is to have the student imagine the plate is the face of a clock. Foods can be described as being located at specific hours (e.g., the green beans are located at 2 o’clock). Students will need to understand clocks for this method to be effective. Many school trays are now rectangular and divided. When a student is using this type of a tray, using “top”, “bottom”, “left”, “right”, and “center” are easy points of reference so long as the student knows those spatial concepts.

Dependent Eaters

For the student that is not yet eating independently, talk to the student with every interaction. Even when the student is not able to understand your words, they will learn to recognize your voice. Tell them what is happening before placing food in their mouth. Be sure and tell them what you’re offering them: “here’s a graham cracker. It’s on the table in front of you. Can you find it?” Do not simply put food in the student’s mouth. At the very minimum, provide the student with a verbal prompt that you are going to give him another bite. Preferably, have the student be a part of the process. Either provide hand under hand assistance the student can anticipate the spoon, or have the student hold onto your wrist as you bring the food toward their mouth. You may find that some students are less resistive when they are given elbow support.

Participate in Serving

As much as possible, encourage the student to be actively involved in preparing, selecting or setting out the food. Avoid having food just “appear”. Remember the students will learn best through hands on experiences. As the student grows, continue to give him verbal information about the location of his food and utensils. Incorporate instruction in basic spreading skills, using a knife safely, stirring skills, pouring a drink, getting a bowl of cereal. Consider providing the opportunity for the students to pour their own drinks. Begin by letting the student pour from another cup into his own. As he becomes more proficient, let him begin to pour from a small pitcher. When it is possible, foster independence by teaching students how to serve food from a bowl or platter and a variety of other serving dishes. The student may also need instruction in using a knife for spreading foods, cutting foods, and how to use a knife (or piece of bread) as a “pusher” to push items onto the spoon. Encourage the student to eat neatly in order to promote social acceptance.

Presentation of Food

When presenting food to a student with low vision use a high-contrast patterned cover, reflective material, or visually interesting ponytail holder on the cup may help a student with low vision to visually attend to the cup. Use a patterned sock around a cup to encourage visual attention in younger students. Use high contrast materials to call his attention to finger foods; for example, place a banana slice on a dark place mat or a pea on a white mat. Avoid busy patterns in tablecloths or place mats. For students with Cortical Visual Impairment, use the students preferred color or use reflective materials to draw their attention to the cup.

When presenting food to a student who is blind or has minimal functional vision, consider the following suggestions. When the student first starts eating at the table, put the food on a plate with an edge or rim that curves up. This will help to keep the food within the center area of the plate, scoop the food, and make it easier to avoid scattering it on the table. Encourage the student to hold his own cup. It may be helpful to use a cup with handles. Try to give the student opportunities to learn to use the spoon, as it will assist in developing his independence and coordination. Place dishes on a tray with raised edges so the student can push the food around without knocking it off the table. Show the student how to use one hand to hold his plate while scooping the food with the other hand.

Embedded Language Opportunities

There are many opportunities for socialization and language during meals. Conversations should be encouraged including explanations of the mealtime activities. The student needs to know that they aren’t the only ones who spill or drop things!